Customizable personal dialysis device having ease of use and therapy enhancement features

ABSTRACT

A peritoneal dialysis machine includes an enclosure; dialysate pump located within the enclosure; a graphical user interface allowing a patient to program a treatment including at least one patient fill performed by the dialysate pump, at least one dwell, and at least one drain performed by the dialysate pump; and the GUI further programmed to provide an alert when it is time to begin the treatment so as to complete the at least one patient fill, dwell and drain by a prescribed time.

PRIORITY CLAIM

This application claims priority to and the benefit as a continuationapplication of U.S. patent application, “Customizable Personal DialysisDevice Having Ease of Use and Therapy Enhancement Features,” Ser. No.12/132,455, filed Jun. 3, 2008.

BACKGROUND

The examples discussed below relate generally to medical fluid delivery.More particularly, the examples disclose systems, methods andapparatuses for dialysis, such as automated peritoneal dialysis (“APD”)and hemodialysis (“HD”).

Due to various causes, a person's renal system can fail. Renal failureproduces several physiological derangements. The balance of water,minerals and the excretion of daily metabolic load is no longer possibleand toxic end products of nitrogen metabolism (urea, creatinine, uricacid, and others) can accumulate in blood and tissue.

Kidney failure and reduced kidney function have been treated withdialysis. Dialysis removes waste, toxins and excess water from the bodythat normal functioning kidneys would otherwise remove. Dialysistreatment for replacement of kidney functions is critical to many peoplebecause the treatment is life saving.

One type of kidney failure therapy is peritoneal dialysis, which infusesa dialysis solution, also called dialysate, into a patient's peritonealcavity via a catheter. The dialysate contacts the peritoneal membrane ofthe peritoneal cavity. Waste, toxins and excess water pass from thepatient's bloodstream, through the peritoneal membrane and into thedialysate due to diffusion and osmosis, i.e., an osmotic gradient occursacross the membrane. The spent dialysate is drained from the patient,removing waste, toxins and excess water from the patient. This cycle isrepeated.

There are various types of peritoneal dialysis therapies, includingcontinuous ambulatory peritoneal dialysis (“CAPD”), automated peritonealdialysis (“APD”), tidal flow dialysate and continuous flow peritonealdialysis (“CFPD”). CAPD is a manual dialysis treatment. Here, thepatient manually connects an implanted catheter to a drain, allowingspent dialysate fluid to drain from the peritoneal cavity. The patientthen connects the catheter to a bag of fresh dialysate, infusing freshdialysate through the catheter and into the patient. The patientdisconnects the catheter from the fresh dialysate bag and allows thedialysate to dwell within the peritoneal cavity, wherein the transfer ofwaste, toxins and excess water takes place. After a dwell period, thepatient repeats the manual dialysis procedure, for example, four timesper day, each treatment lasting about an hour. Manual peritonealdialysis requires a significant amount of time and effort from thepatient, leaving ample room for improvement.

Automated peritoneal dialysis (“APD”) is similar to CAPD in that thedialysis treatment includes drain, fill, and dwell cycles. APD machines,however, perform the cycles automatically, typically while the patientsleeps. APD machines free patients from having to manually perform thetreatment cycles and from having to transport supplies during the day.APD machines connect fluidly to an implanted catheter, to a source orbag of fresh dialysate and to a fluid drain. APD machines pump freshdialysate from a dialysate source, through the catheter, into thepatient's peritoneal cavity, and allow for the dialysate to dwell withinthe cavity and for the transfer of waste, toxins and excess water totake place. The source can be multiple sterile dialysate solution bags.

APD machines pump spent dialysate from the peritoneal cavity, throughthe catheter, to the drain. As with the manual process, several drain,fill and dwell cycles occur during dialysis. A “last fill” occurs at theend of APD, which remains in the peritoneal cavity of the patient untilthe next treatment.

While APD has obvious lifestyle benefits over CAPD, there is still aneed to make dialysis treatments more patient friendly. Also, there areongoing attempts to bring blood-based dialysis, e.g., HD into thepatient's home rather than a center. The embodiments of the presentdisclosure attempt to address user ergonomics for both types oftreatment.

SUMMARY

The embodiments described herein discuss a dialysis machine, such as aperitoneal dialysis machine. The machine includes many features andapparatuses that make the dialysis treatment more palatable andpersonalized, easier to learn and use, and less prone to error.

In one primary embodiment the peritoneal dialysis machine includes aprojector or scanning laser that projects therapy information or otherinformation onto a surface external to the dialysis instrument, such asa ceiling, wall, piece of furniture, etc. The information can bedisplayed with relatively large text, so that the patient or caregivercan more readily see the information. The information can also beprojected onto a surface that allows the patient or caregiver to viewthe information without having to turn towards the dialysis instrument.

The projected information can include treatment information such as pumpfill, dwell and drain information. For example, if the instrument iscurrently filling the patient, the projector can display onto the remotesurface the total fill volume and the amount of the fill that hascurrently taken place. This can be done quantitatively (via the displayof numbers) or pictorially, e.g., via a volume representing total fill,which incrementally changes color indicating current fill level.

Other information can include for example total number of exchanges,current exchange, current time, time remaining for treatment, totalultrafiltration (“UF”) to be removed, amount of UF currently removed,ambient temperature, dialysate temperature and other information asdesired.

The projector in one embodiment is provided in addition to likeinformation displayed by a display device, which is part of the overallgraphical user interface of the dialysis instrument. For example, thedisplay device can display information during therapy, a portion or allof which is projected onto a room wall or other surface. The instrumentin one embodiment includes a switch that allows the patient or caregiverto turn the projector on and off. The switch can be located on themachine or be a remote switch (tethered or wireless) that allows thepatient to display the information when desired.

In another primary embodiment, the dialysis instrument takes proactivesteps to ensure that the patient's prescribed therapy is completed by atime specified by the patient or caregiver. For example, the patient mayneed to wake-up by 7:00 AM for work. The patient's dialysis thereforeneeds to be completed by such time and indeed may require additionaltime for patient disconnection.

In one implementation, the fill time, dwell time, drain time are set,e.g., by a physician. The fill time and drain time can be set directlyor by setting fill/drain volume and pump rate. In either case, the totaltreatment time is set. Here, the dialysis instrument can be configuredto alarm or alert when it is time to begin treatment so as to finish ontime, e.g., at 7:00 AM. The alert can be an audio, visual, audiovisualalert or tactile (e.g., a vibrating alert on a wearable remotevibrator).

In another implementation, the patient's dwell time is variable. Here,the instrument automatically adjusts the dwell time to attempt to makethe treatment end by the prescribed time, e.g., 7:00 AM. The machine canbe configured to dwell as long as possible, while completing therapy bythe presented time. The machine can be set to have a minimum dwell timesuch that machine has to dwell for at least the minimum time. Each dwellcan be set to be the same duration or to have different durations. Forexample, the first dwell can be longer than the second dwell, and so on.

In another primary embodiment, the dialysis machine provides additionalmodes of input for helping the patient control the dialysis therapyincluding the pumping of dialysate to and from the patient. For example,the machine can include a projector that projects a virtual keyboarddisplay onto a surface, such as a board or book, or machine restingsurface, so that the keys are larger than is possible on the dialysisinstrument. The patient or caregiver uses the projected keyboard toenter information into the dialysis machine. The patient presses buttonson the virtual keyboard to enter information into the peritonealdialysis machine, such as therapy information or text that is sent fromthe dialysis instrument over an internet as electronic mail. Theprojector in one embodiment is mounted to or rested on the surface ontowhich the virtual keyboard is displayed. The present system includes aboard with a holding apparatus into which the virtual projector issnap-fitted. The board can be tilted for use in the patient's bed orchair without the projector coming free from the board.

In another implementation, the instrument includes a touch screeninterface that provides tactile feedback. The tactile feedback isprovided for example by molding tactile bumps or information into thetactile overlay itself, into a separate sheet that is applied on top ofthe touch screen overlay or as epoxy beads that are screen printed ontothe touch screen overlay. The touch screen overlay is then attached tothe video monitor in the standard manner. The tactile bumps are locatedat set X-Y areas on the video monitor. However, different informationcan be displayed at different times on the video monitor for the sametouch screen tactile bump.

In a related implementation, the instrument includes a Braille userinterface. The Braille user interface can be set at the factory orinserted onto or over a standard user interface. The Braille keys orcharacters can be provided via the touch screen tactile feedback bumpsdisclosed herein. The Braille keys or characters can be numbers forentering data or answer words, such as “yes” and “no”, which are pressedto answer questions posed by the dialysis instrument, e.g., duringtherapy setup.

In still another implementation, the instrument includes atelecommunications device for the deaf (“TDD”) user interface for deafor hearing impaired patients. Here, the dialysis instrument incorporatesa keyboard (hard or touch screen) and a screen, such as an LED or LCDscreen to display typed text electronically. Text is transmitted to thescreen live, e.g., via telephone line or cable connected to the dialysisinstrument. The patient can respond using the keyboard to enterinformation, which the TDD converts to audible sounds that aretransferred over the phone line. The dialysis instrument can alsoprovide voice guidance information to the user, which a deaf or hearingimpared person cannot hear. It is also contemplated to allow voiceguidance to be deactivated and for the instructions to be displayedinstead on the instrument screen.

In a further primary embodiment, the present disclosure includes agraphical user interface (“GUI”) having ease of use, ease of learning,patient preference and patient assist features. For example, thedialysis system can have an alarm clock, which provides a therapy startalert as described above. The clock in one embodiment includes a timerthat allows the patient to set a time for a certain procedure such as amid-day exchange. The user interface in another implementation includesan audio-in connector, so that the patient can use speakers provided inthe instrument for external sound-producing devices. Alternatively oradditionally, the instrument includes an audio-out connection, whichenables the instrument audio to be played on external speakers.

It is also contemplated the instrument with an audio option to playsoothing or relaxing music or sounds during therapy.

Still further, the instrument can have patient assist lighting, such asa night light or reading light.

In one embodiment, the GUI includes a calendar that allows patients toinsert important therapy information at certain dates, such as doctorvisit time and date, effluent sample taking dates, or non-therapyrelated dates.

It is yet further contemplated to allow the patient to customize theinstrument for example by allowing the patient to set a screen-saver,wall paper and/or background for the GUI.

In yet another primary embodiment of the present disclosure, theinstrument enclosure or housing is provided with patient assist andcustomizable features. For example, the enclosure in one implementationhas a utensil holder, such as a vase for flowers, which doubles as a penholder. The enclosure in one embodiment includes a grip-assist device,which aids patients, e.g., elderly patients in removing caps frombottles. Similarly vein, the enclosure includes fingers or otherapparatuses to remove pull-caps from containers and/or a device thataids the patient in breaking a tubing frangible. The enclosure canfurther include a supply drawer and a clamp for temporary disconnectionof the patient from the dialysis instrument.

The instrument enclosure of the present disclosure can also becustomized for the patient. The bezel around the GUI is interchangeablewith a plurality of different bezels so that the patient can choose adesired bezel. It is also contemplated to provide different coloredcovers so that the patient can choose a desired color, e.g., one thatmatches a room in which the instrument is likely to be used. Besidescolor, the decorative bezel/panel can also simulate various materialpatterns and finishes (e.g., wood, stone, floral pattern, etc.) to matchthe patient's domestic environment.

It is therefore an advantage of the present disclosure to provide adialysis instrument that is easier for the patient to learn, use andcustomize.

It is another advantage of the present disclosure to provide aninstrument that assists hearing impaired patients.

It is a further advantage of the present disclosure to provide aninstrument that assists patients with visual impairments, hearingimpairments and manual dexterity impairments (e.g., in the latter caseto provide devices that remove caps and break frangibles)

It is a further advantage of the present disclosure to provide adialysis instrument that the patient can customize.

Additional features and advantages are described herein, and will beapparent from, the following Detailed Description and the figures.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a schematic logic flow diagram illustrating one embodiment ofa peritoneal dialysis system configured to alert the patient when it istime to begin treatment.

FIG. 2 is schematic logic flow diagram illustrating one embodiment of aperitoneal dialysis system configured to modify the dialysate dwelltimes to complete dialysis based on a starting time of the dialysistreatment.

FIG. 3 is an elevation view illustrating an alarm feature screen for adialysis system of the present disclosure.

FIG. 4 is an elevation view illustrating another alarm feature screenfor a dialysis system of the present disclosure.

FIG. 5 is an elevation view illustrating a further alarm feature screenfor a dialysis system of the present disclosure.

FIGS. 6A to 6C illustrate various dwell time distributions of thedialysis system of the present disclosure.

FIG. 7 is an elevation view illustrating yet another alarm featurescreen for a dialysis system of the present disclosure.

FIG. 8 is an elevation view illustrating a timer function screen for adialysis system of the present disclosure.

FIG. 9 is an elevation view illustrating a calendar function screen fora dialysis system of the present disclosure.

FIG. 10 is an elevation view illustrating a customize options screen fora dialysis system of the present disclosure.

FIG. 11 is a perspective view of one embodiment of a dialysis instrumenthaving multiple patient-assist features.

FIG. 12 is a perspective view of another embodiment of a dialysisinstrument having multiple patient-assist features.

DETAILED DESCRIPTION

Dialysis patients desire machines or systems that tend to blend into thehome environment rather than one that looks like a medical device. Manyautomated peritoneal dialysis (“APD”) patients desire to have the APDinstrument near their beds to facilitate interaction with the machineduring the night, e.g., to read status, interpret and correct alerts,etc. It has been observed that in many patient use settings, the deviceis placed someplace other than the patient's nightstand. In some ofthose cases, the patient has reserved the nightstand for such items asan alarm clock, flower vase or light. The machine of the presentdisclosure provides room for these and others items and allows the APDinstrument and the other items to be placed near the patient's sleeparea. The instrument facilitates interaction with the machine, whileallowing for the personal items to be present.

Patients commonly use APD devices in the bedroom while they and/or theirpartner sleeps. The instrument of the present disclosure also includesfeatures that help the patient sleep more deeply and comfortably,promoting good health. The features can also directly help the patient'spartner sleep better or indirectly help the partner by not waking thepatient, who can wake the partner potentially.

Further, different patients have different tastes, styles and homesettings. The APD machine of the present disclosure accordingly includesa machine capable of displaying one of multiple industrial designs andcolor schemes, instead of forcing a single design and scheme on thepatient. The systems herein allow the patient to personalize theirdevices to fit better within the patient's particular home environment.

As discussed next, the instrument can also be programmed to wake thepatient at a desired time and to ensure that a proper therapy has takenplace prior to the wake time.

Referring now to the drawings and in particular to FIG. 1, logic flowsequence 10 illustrates one automated example for alerting or notifyingthe patient when it is time to begin treatment. Many peritoneal dialysistreatments are performed at home while the patient sleeps. While thefill, dwell and drain sequences discussed herein pertain to peritonealdialysis (“PD”), the teachings of FIG. 1 apply also to a homehemodialysis treatment. Logic flow sequence 10 is run by a processor andmemory located within the dialysis instrument or machine (see FIGS. 11and 12). Sequence 10 as shown reminds the patient to begin therapy by acertain time, so that therapy is completed properly and the patient isable to end treatment at a desired time.

Upon starting sequence 10, as shown at oval 12, the dialysis instrumentis programmed to run X number of cycles of exchanges. Each cycle orexchange has a set drain, fill and dwell time, which yields an overalltreatment duration, as seen in connection with block 14. The drain, filland dwell times are set in one embodiment by a clinician, nurse ordoctor. Alternatively, the dialysis instrument provides the ability forthe patients to manipulate the fill, dwell and drain times as shownherein. In either case, the drain, fill and dwell times are entered atstep 14. Further alternatively, fill volume, drain volume and pump rateare entered and the fill time and drain time are outcomes for thoseparameters. In such case, fill and drain times are estimated via volumeand rate.

As seen in connection with block 16, the dialysis instrument is alsoprogrammed to know when the patient desires to have treatment completed.Different embodiments for entering this information are shown below.

At block 18, the dialysis instrument calculates when to alert thepatient to begin treatment knowing the overall treatment duration andthe desired time of completion. In one embodiment, the processing andmemory are configured to allow a predetermined amount of time fortherapy setup, e.g., fifteen minutes. The predetermined amount of timecan for example be set at the factory and later modified by the patientas the patient becomes more familiar with the therapy setup. Theinstrument alerts the patient to begin therapy setup fifteen minutesbefore therapy needs to begin to run the known fill, drain and dwellcycles a number of times to be completed by the patients desiredcompletion time. At step 20, the dialysis instrument provides such analert to the patient which can be an audio, visual or audiovisual alert,which signals the patient to begin therapy setup. The alert can be localor provide at or from the dialysis instrument. Alternatively, the alertis remote, e.g., sent via a wireless data link to the patient's cellphone or pager. The wireless data link can be via BlueTooth™ technology,for example.

Sequence 10 in connection with diamond 22 determines whether the patienthas begun treatment. If the patient has not begun treatment, thedialysis system continues to provide the start therapy alert and a loopbetween block 20 and diamond 22 continues until the patient heeds thealert and begins treatment, at which time sequence 10 ends as seen inconnection with oval 24.

Sequence 10 of FIG. 1 assumes preset dwell times, which each may be thesame dwell time or the dwell times can differ. Sequence 50 of FIG. 2allows the dwell times to be adjusted, so that the therapy is completedby the time that the patient sets. This can be done as long as a minimumdwell time for each cycle or exchange is provided. Sequence 50 starts atoval 52, wherein the dialysis instrument is programmed to run X numberof cycles or exchanges. Each cycle or exchange having a set orcalculated drain time and fill time, but wherein at least one of thedwell times if not more than one or all of the dwell times areadjustable, as seen in connection with block 54.

At block 56, the dialysis instrument is programmed to know when thepatient desires to complete treatment. End time T2 is entered by thepatient in various ways shown below, and as seen in connection withblock 56. At block 58, the patient begins treatment at time T1, which isstored in the dialysis instrument. At diamond 60, sequence 50 determineswhether a total treatment time equal to T2-T1 allows enough time for aminimum amount of dwell to occur given the set or estimated fill anddrain times. Another way of stating this is that the dialysis instrumentsets a lower dwell time limit and determines whether the total treatmenttime meets that limit based on the minimum dwell time plus the fill anddrain times.

If the treatment time T2-T1 does not support or allow for enough dwelltime, the dialysis instrument provides an audio, visual or audiovisualalarm to the patient as seen in connection with block 62, after whichsequence 50 ends, as seen in connection with oval 68. If treatment timeT2-T1 does support or allow for enough total dwell time, sequence 50determines durations for each dwell type cycle based on treatment time(T2-T1), expected drain times and expected fill times to finishtreatment by the patient ended time T2.

As discussed, the expected fill and drain times can be preset or becalculated based on known flowrate data and total volume filled andtotal volume drained. For example, assuming the fill flowrate to beconstant, the total fill time is the total fill volume divided by thefill flowrate. Likewise, assuming a constant drain flowrate, a totaldrain time is the total drain volume divided by the average or constantdrain flowrates. Fill and drain flowrates can vary, such that theflowrates can be averaged, wherein the average flowrate is used. It isalso likely that the total drain volume will need to provide someestimation of the amount of excess water or ultrafiltrate that isremoved from the patient. Thus, in one embodiment, the total drainvolume is the fill volume of dialysate plus amounts of the patient's UF,which can be calculated knowing the patient's initial weight, thepatient's dry weight and the average density of ultrafiltrate.

FIGS. 6A to 6C below illustrate various dwell time distributions fordividing up the total dwell time calculated in connection with sequence50. Once the individual dwell times are determined the treatment isperformed as seen in connection with block 66 and sequence 60 ends asseen in connection with oval 68.

Referring now to FIG. 3, a screen 70 from the dialysis instrument showsone embodiment for allowing the patient to enter the time that thepatient wishes treatment to be completed, which is used in bothsequences 10 and 50. Screen 70 can operate with a touch screen overlayand touch screen controller, which sends information entered onto screen70 by the patient to processing in memory within the instrument toperform either of sequences 10 or 50. Alternatively, a portion or all ofthe items inputted into screen 70 are done offscreen via membraneswitches or other type of electromechanical input devices.

Screen 70 displays a message 72, which can be audio, visual oraudiovisual and which informs the patient to enter the time that thepatient would like the machine to wake the patient and to remind thepatient to leave enough time at the end of therapy to properlydisconnect from the dialysis machine. Screen 70 displays a numerickeypad 74, which in an embodiment is a touch screen operated keypad. Thepatient enters the time in hours and minutes and sets whether such timeis AM time or PM time. Screen 70 displays the entered time and whetherthe time is AM or PM at display area 76. If the patient is satisfiedwith the time and AM/PM setting, the patient presses enter 78 to advanceto a next step in the therapy setup. In one embodiment, if the patientpresses an incorrect or undesirable time before selecting enter 78, thepatient can enter new numbers that are written over the old numbers.Alternatively, screen 70 provided a “back” input that allows the patientto erase a number and press a new number in its place.

Referring now to screen 80 of FIG. 4, the dialysis instrument after thepatient enters the desired alarm time displays the alarm time in displayarea 82 and provides an audio, visual or audiovisual message 84 that thepatient's therapy will be completed by the entered time and that themachine will wake the patient at that time. Message 84 further remindsthe patient that according to the patient's prescription and the enteredalarm time, the patient should begin therapy at or before 10:00 PM Themachine accordingly alerts the patient at the start of therapy at 9:45PM leaving a predetermined amount of time (e.g., 15 minutes) for therapysetup. Screen 80 provides an additional input device 86 that allows thepatient to change the allotted setup time, e.g., for fifteen minutes toa different amount of time.

Screen 90 of FIG. 5 illustrates one implementation of sequence 50 ofFIG. 2. Here again, the example alarm time or end of therapy time of6:00 AM is illustrated in display area 82. An audio, visual oraudiovisual message 86 informs the patient that the therapy will becomplete at that time and also reminds the patient to begin therapy byno later than 12:00 AM to avoid an alarm condition, which is detected atdiamond 60 of sequence 50, which occurs when the total amount oftreatment time does not leave enough dwell time for an effectivetreatment. The machine also informs the patient that the machine willmodify the therapy automatically based on the time that the patientactually starts therapy and alerts the patient at no later than 11:45 PMto begin treatment. Depending on the time that the patient actuallystarts therapy, the machine automatically adjusts the dwell times basedon calculated or estimated fill and drain times.

Referring now to FIGS. 6A to 6C, various dwell distribution percentagesare illustrated. The dwell distribution percentages are used for examplein connection with sequence 50, in which a total dwell time iscalculated using total treatment time, estimated or calculated totalfill time and estimated or calculated total drain time. Once the totaldwell time is known, the dwell time is split according to thedistributions of FIGS. 6A to 6C. Each distribution assumes threeexchanges or three dwell times, however, different numbers of exchangescan be used. Further, the distribution does not take into account thefinal fill, which is typically done in PD, wherein the final fillremains in the patient's peritoneum until the next treatment, whichbegins with a drain of the previous day's final fill. Thus, while threedwells are shown, the treatment would actually include four fills, thefourth fill being the last fill.

FIG. 6A shows a distribution in which the dwell times are equal. FIGS.6B and 6C illustrate alternative distributions, which assume that thegreatest amount of clearance occurs at the beginning of therapy when theamount of toxins and waste in the patients body are the highest. Frontloading the dwell period allows the longest dwell time to occur when thepatient is most toxic. Distribution of FIG. 6B splits the remainingdwell time between dwells two and three equally. The distribution of 6Cshortens dwell three from dwell two, which in turn is shortened fromdwell one.

Referring now to FIG. 7, screen 92 of the PD or HD system illustratesone embodiment of an alarm or wake-up screen of the present disclosure.An audible alarm from speakers 188 (FIGS. 11 and 12) can accompanyscreen 92. Screen 92 also displays an audio, visual or audiovisualmessage 94 that therapy has been completed successfully. Message 94 alsoincorporates an input (touchscreen or otherwise) that allows the patientto view therapy details. Screen 92 further includes additional alarmapparatus, namely, a snooze input 96 (touchscreen or otherwise) and analarm of input 98 (touchscreen or otherwise). In one embodiment, thedialysis instrument continues to display message 94 during the snoozedwell period.

Referring now to FIG. 8, screen 100 of the PD or HD instrumentillustrates a timer function. The timer function is provided to thepatient as a reminder tool, for example, to allow patients to set a timeto interrupt treatment for a desired purpose, such as to retrieve anitem, pick-up a person, attend to a meal or other function or to performany action needed, which is going to occur during the course oftreatment (which can last up to eight hours for example). The timerfunction is likely used during the daytime while the patient is awake orresting, however, the timer function can be used during the night whenthe patient is sleeping to wake the patient for any desired purpose.Thus it is expressly contemplated to combine the timer function with thewake feature or use the timer function as the wake feature in theevening or at anytime at which the patient may need a prompting.

Screen 100 includes a message 102 indicating that the patient hasselected the timer function. Keypad 74 (e.g., touch screen keypad) isprovided. A start timer display 104 and a timer countdown display 106are also provided. The timer function also includes enter input 78,which the patient presses to move to a different screen in the setup oroperation of the dialysis machine.

The patient enters a time for the timing function or countdown to beginusing keypad 74 to punch the time in hours and minutes. The entered timeis displayed in timer start time display 104. The entry of the timerstart time is performed and displayed in the same manner as the alarmawake time entered via keyboard 74 and displayed via display area 76 asdiscussed above in connection with screen 70. The patient then enters ina similar manner the amount of countdown time in hours and minutes,which is displayed in timer countdown time display 106. Although notillustrated, individual visual, audio, audiovisual messages can beprovided to prompt the patient to enter in sequence the timer start timeand the timer countdown time. Alternatively, either setting can be madeprior to the other.

Once the patient enters the timer start time and the timer countdowntime and confirms entry via enter button 78, the dialysis machine beginsthe timer countdown at the designated time and counts down an amount oftime entered at display 106. At the end of the countdown, the machinecan be configured to provide an audio, visual or audiovisual alert tothe patient. The machine at the end of the countdown can also display acancel or end alarm input that allows the patient to stop the alarm oralert and continue with any desired activity.

Referring now to FIG. 9, screen 110 illustrates one embodiment of acalendar function, which can be implemented in the dialysis instrumentof the present disclosure. Screen 110 includes a message 112, whichaudibly, visually or audiovisually informs the patient that the patienthas selected the calendar function. In the illustrated embodiment, thecalendar function operates with a touch screen overlay as discussedabove. Alternatively soft keys or dedicated membrane switches are usedto enter information into the calendar function.

Message 112 informs the patient to touch a date to make the dateenlarge, so that information can be entered or edited in the enlargeddate. A keyboard provided by the instrument (touch screen keyboard orkeyboard via embodiments shown in connection with FIGS. 11 and 12) isused to enter the information. When the patient is finished entering orediting information within the enlarged date, the patient touches theenlarged date which then shrinks back to its original size and position.Message 112 also indicates to the user that the processing and memorywithin the dialysis instrument retains the information entered into thecalendar, so that the information will be displayed the next time thepatient recalls the calendar function and even after one or more powerdown.

The calendar function on screen 110 also includes month inputs 114,which allow the user to select a particular month to view and edit. Inthe illustrated embodiment, the selected month, May, is highlightedalong the row of inputs 114. The selected month and year are also shownon the sides of calendar 116. Inputs 114 include arrow keys that areprovided for shifting the months into past or future years. Calendar 116includes each of the days of the week and each of the days of theparticular month for the particular year.

The selected month of May illustrates example entries that the patienthas made. For example, the patient has entered for a reminder that thereis a doctor's appointment on the Ninth of May. The patient is scheduledto baby-sit on May 19. A birthday is to occur on May 22, and the patientis on vacation from May 29 to May 31.

It is also contemplated that when the date is selected and enlarged, atwelve hour or twenty-four hour time entry menu is displayed, such thatthe patient can enter a particular time for the doctor's appointment,babysitting, birthday party, flight times, etc., for a given day. Thepatient uses a keyboard entry via one of the embodiments discussed belowto enter the specific time information. It is accordingly furthercontemplated that the dialysis machine provide an alarm or alert to thepatient at a prescribed time before the particular time entry. Forexample, if the patient's doctor's appointment is 11:00 AM, it iscontemplated to program dialysis machine to alert the patient at 10:30AM or 10:45 AM to remind the patient of the appointment.

Referring now to FIG. 10, screen 120 of the dialysis instrumentillustrates one embodiment for a customize/options feature of thedialysis system of the present disclosure. Screen 120 is againimplemented in one embodiment using a touch screen overlay but isalternatively maneuvered through via soft keys or membrane switches.Screen 120 includes an audio, visual or audiovisual message 122 thatinforms a patient that the patient has selected the customize optionsfeature, which allows the patient to customize the machine and therapy.In the illustrated embodiment, the customize/options feature allows thepatient to customize any one or more of a background screen at drop menu124, background music via a background music menu 126 and a voice for avoice guidance feature via voice guidance dropdown menu 128.

In one embodiment, the processing and memory are configured such thatwhen the patient presses the arrow associated with any of menus 124, 126and 128, the associated selections or options appear. Before such time,menus 124, 126 and 128 show only the currently selected backgroundscreen, background music and voice for the voice guidance feature. Eachmenu 124, 126 and 128 is shown having five options. More or less optionscan be provided. Further, the displayed options are for illustrationpurposes only and can also be modified as desired.

In the illustrated background dropdown menu 124, the patient can choosebetween a plain background, a bliss background, a coffee background, afeather background or a upload picture option, which allows the patientto upload a picture onto the instrument screen as the background. Whenthe patient selects the upload picture feature, the customize optionscreen prompts the user to make a data communications connection, suchas a serial connection to a computer or camera, a modem connection to aninterne or a wireless connection to a data output source, to transfer adesired background to screen 120.

Likewise, the background music dropdown menu 126 shows variousselections, such as soothing background music, whale calls, waterfall, ano background music option and a customize background music option.Selecting the customize or upload music option causes screen 120 toprompt the user again to connect via any of the above data communicationmodes to a device capable of storing music, such as a computer, MP3™player, Ipod™ music player, etc.

The voice guidance dropdown menu 128 of customize/options screen 120allows the patient to select a voice that audibly guides the userthrough therapy setup, procedures taken at the end of therapy, andpossibly for alerts occurring during therapy (also sets language fortext messages appearing on the screens described herein). Example voiceguidance selections on dropdown menu 128 include an English speakingmale, an English speaking female, a Spanish speaking male, and a Spanishspeaking female. Other languages can be added or used instead asdesired. Further, the patient can select via customize/options theoption of having no voice guidance at menu 128, which would set Englishas the default setting for the text messages or invoke a sub-menu thatallows the user to select a language for text messages.

Referring now to FIG. 11, dialysis instrument 150 illustrates manyadditional patient friendly features for the dialysis system of thepresent disclosure. Dialysis system 150 does not have to include each ofthe features shown herein, however, FIG. 11 illustrates one embodimentfor each of the features. Further, it is contemplated to combine atleast some of the features of dialysis system 150 of FIG. 11 with thoseof the system 200 of FIG. 12. The goal or intent of the features shownin connection with FIGS. 11 and 12 is to make the dialysis instrumentmore personalized, easier to use, more enjoyable to use and/or moreeffective.

To allow the patient to personalize the dialysis instrument, dialysisinstrument 150 in one implementation is provided with a photographholder 152. Photograph holder 152 is shown being connected hingedly to atop surface 154 of dialysis instrument 150 via a hinged connection 156.Thus, picture holder 152 can be folded down and out of the way if notused. FIG. 11 shows picture holder 152 in use, which allows the patientto insert one or more photographs to personalize the instrument andtreatment. While dialysis instrument 150 is shown as having a singlepicture frame 152, it is contemplated to provide multiple picture frameswith instrument 150.

Housing 160 of instrument 150 is further modified to include a flower orwriting utensil holder 162. Utensil holder 162 can be formed integrallywith top 154 of housing 160 or be formed separately from housing 160 andconfigured to be removably attached to top 154.

Dialysis instrument 150 also includes a customizable or selectable frontbezel 158, which the patient can choose to match the patient'senvironment or to otherwise personalized instrument 150. Bezel 158 canbe selected at the time instrument 150 is ordered and fitted at themanufacturing facility. Alternatively, bezel 158 can be removed andreplaced readily by the patient and switched at different times as thepatient desires. Likewise, it is contemplated to provide the outer shellor housing 160 of dialysis instrument 150 in a color or colors that thepatient desires. Besides color, the decorative bezel 158 can alsosimulate various material patterns and finishes (e.g., wood, stone,floral pattern, etc.) to match the domestic environment.

Instrument 150 includes a display device 170, which as described aboveoperates in one embodiment with a touch screen overlay. Display device170 as illustrated above selectively displays other personalizingfeatures or options, such as patient selectable screensavers, wallpaper,backgrounds, etc. It is contemplated to provide the touch screen overlaywith tactile feedback to produce a touch screen button 172, which whenpressed provides tactile feedback to the patient or user. One apparatusfor providing a touch screen with tactile feedback is discussed in U.S.Pat. No. 5,412,189, entitled, “Touch Screen Apparatus With TactileInformation”, the entire contents of which are incorporated herein byreference.

In the patent, tactile information (31 to 34) is molded into a touchscreen surface (30) when the touch screen surface is initiallymanufactured. An example is given in which if the touch screen surface(30) is made of glass, molten glass is forced into a mold that includestactile information (31 to 34). Another method of connecting the tactileinformation (31 to 34) to touch screen surface 30 discussed in thepatent is to cover the touch screen surface (30) with a clear plasticsheet having tactile information (31 to 34) molded or punched thereon.For example, the plastic sheet could be pressed in a mold containing thetactile information, heated to deform the plastic sheet to the shape ofthe mold, and allowed to cool. This plastic sheet can then cover all orsome of the touch screen surface, affixed either by surface tension oradhesive.

It is understood by the inventors of the present disclosure that touchscreens are typically plastic overlays that are connected to the glassof the video monitor. Thus the present inventors contemplate anadditional embodiment in which the “tactile information” or tactilebumps are molded into the touch screen overlay itself. The touch screenoverlay with integral tactile bumps is then attached to the videomonitor in the standard manner. Here, an additional plastic sheet is notneeded.

A further alternative method disclosed in the patent is to apply smalldrops of clear epoxy to the touch screen surface (30) to form thetactile information (31 to 34). Here, a mask is used to insure properpositioning of the tactile information on touch screen surface (30). Theepoxy is disclosed as being selected so as to dry to a relativelytransparent consistency so as not to unacceptably interfere with theappearance of any visual data underneath the tactile information. Lenseffect errors are disclosed as being minimal as long as the tactileinformation is not overly large.

The tactile information or bumps 178 are set at various X-Y positions onthe display device 170 of FIG. 11. Tactile information or bumps 178 canbe shown in connection with any information useful for instrument 150.For example one of the tactile bumps 178 can be associated with a firstdisplayed selection on a first screen. The same tactile bump 178 is thenassociated with a second displayed selection on a second screen ofdisplay device 170. Even when tactile information or bumps 178 areBraille keys or characters as discussed below, the Braille keys can formthe words “yes” and “no” and accordingly be associated at differenttimes with different therapy queries, such as therapy setup questions,that each can be answered with either a “yes” or a “no”.

As discussed, instrument 150 includes or can include off screen inputdevices, such as a dial 174 or membrane switch 176. In one embodiment,membrane switch 176 operates as a soft key to provide different inputfunctionality based on different information displayed on display device170. Accordingly, membrane switch 176 includes an arrow that points to aparticular region of the display screen that may contain varying text orgraphics depending on the function/feature currently associated with themembrane switch.

FIG. 11 illustrates one option for modifying instrument 150 to be moreeasily used by blind patients. Here, Braille keys or characters 178,which can be affixed to or formed with the touchscreen overlay, areraised or offset from the overlay surface a distance sufficient suchthat the mere touching of a Braille key 178 is not sufficient to enteran input into machine 150 to protect against inadvertent swipes.However, a pressing or pressure applied to a particular key 178 issufficient to cause a change in capacitance or resistance at thecorresponding X-Y coordinate of the particular Braille key, which issensed and which causes the input of that character to be placed intomemory and used by a processor for inputting data into instrument 150.In this manner, blind patients or patients that are visually impairedcan communicate information to instrument 150 to setup therapy, modifytherapy, or even to send a message from instrument 150 through anelectronic mail or over the internet to an on-call clinician orphysician.

Besides the “yes” and “no” Braille keys, it is contemplated to provide aBraille keypad for the patient to enter information. Here, the displayof Arabic numbers beneath or directly adjacent to the correspondingBraille character would likely be fixed from screen to screen.

Instrument 150 also includes clamps or clamping devices 164 that aresized to hold and clamp a patient line, which extends for example from adisposable cassette loaded into instrument 150. As discussed above, thepatient if awake can halt or interrupt a treatment if needed. To do so,a patient performing PD disconnects the patient line from a catheterthat is implanted into the patient's peritoneum. Clamps 164 allow thepatient to place the patient tube against housing 160 of instrument 150and clamp the patient line, so that fresh dialysis fluid is not wastedand to prevent fluid from leaking from the disposable unit placed insideinstrument 150. Clamps 164 also act to preserve the sterility orcleanliness of the disposable unit.

In certain instances, the patient has to break or sever a frangible sealthat is placed inside a piece of tubing, for example inside the patientline. Certain patients, especially elderly patients, can have difficultybreaking the frangible. In one embodiment therefore instrument 150includes a member 166 which can fold down from housing 160, and whichthe patient uses to provide leverage against which to break thefrangible. In the illustrated embodiment, member 166 includes a pair oflegs. The tube at the frangible section is wedged below one of the legsand above the other of the legs to provide leverage against which tobend the tube and break the frangible seal. Member 166 is usedalternatively and/or configured alternatively to assist in eithergripping twist caps or pulling pull caps from an associated container.

In the illustrated embodiment, dialysis instrument 150 also includes adrawer 168, which the patient can open to insert or retrieve therapysupplies, an automated or manual patient-line connection device or otheritems that the patient wishes to store at or near dialysis instrument150. In the illustrated embodiment, drawer 168 slides into instrument150 when not in use, such that the drawer is kept out of the way whennot needed. A tab or other locking device can be provided to lock drawer168 in place when instrument 150 is being moved, for example.

Instrument 150 of FIG. 11 is also fitted with a light or lamp 180, whichcan be a reading light, light emitting diode (“LED”), night light andhave any suitable intensity and size. In the illustrated embodiment,light 180 is attached to top 154 of housing 160 via an armor coated wirewhich can be bent and formed so that light 180 can be fixed at a desiredposition. Further, light 180 can be tilted towards and away from thepatient to adjust the amount of light directed at the patient. In theillustrated embodiment, top 154 includes a groove or aperture 184 foraccepting positionable cord 182 and light 180, so that the light andcord tuck out of the way and do not appreciably increase the overallsize and profile of instrument 150. While light 180 is shown connectedvia armor plated cord 182 to top 154 of dialysis instrument 150, it iscontemplated to attach light to other surfaces of housing 160, such asone of the sides or back of the housing.

It should be appreciated that groove or aperture 184, writing utensilholder 162, and picture frame 152 are shown at the top of instrument 150for ease of illustration. Placing crevices, grooves and other liquidcollecting structures as the top of the instrument could lead to thewetting of components within the instrument. Accordingly, one or more ofthese features is fixed alternatively to one of the sides of instrument150. Also, groove or aperture 184, for example, can be replaced with aclip into which cord 182 of lamp 180 snap-fits.

Instrument 150 also includes a number of electronic features, which makethe dialysis instrument and treatment easier to learn and use and moreeffective. In one embodiment, instrument 150 is provided with a chargingand docking station 186 that allows the patient to dock and charge thepatient's MP3™ player, Ipod™ player or other music storage device tocharge the device and/or play music from the device, for example throughspeakers 188 located inside instrument 150. Instrument 150 also includesan audio line output 190 that allows the music to be sent from theinstrument to external speakers. Instrument 150 further includes anaudio line input 192 that accepts sound or music from an external sourceand plays the sound or music through speakers 188. Speakers 188 are alsoconfigured to output the voice guidance and internally stored backgroundmusic discussed above in connection with FIG. 10. It is furthercontemplated to provide a music storage device within dialysisinstrument 150, wherein a data connection between instrument 150 and asong providing outlet, such as the internet, enable instrument 150 todownload songs for direct storage into memory of instrument 150.

As discussed above, instrument 150 in one embodiment provides voiceguidance to the patient or user. It is also contemplated that instrument150 receive voice instruction from the patient or user. For example, inaddition to or instead of Braille keys 178, the voice recognitionsoftware can greatly enhance the interaction of device 150 with blind orvisually impaired patients. Further, voice data input can be a preferredoption for any patient who desires to input data, while having handsfree to perform other duties. Accordingly, instrument 150 in oneembodiment includes a microphone 194 that accepts audible commands fromthe patient or user. The output of microphone 194 is coupled to aprocessor within instrument 150, which processes the audible input usingsoftware to convert the audible command to a data input into machine150. It is further contemplated to provide voice recognition softwarethat prevents outside noise or people other than the patient orclinician from making changes to therapy settings within instrument 150.

Instrument 50 illustrates a further electronic feature for enhancing theoperability and effectiveness of the dialysis instrument and treatment.Here, instrument 150 is provided with a light projecting apparatus 196that projects information from the machine onto a surface that thepatient can view more readily than screen 170. For example, projector196 can project information onto a wall or ceiling of the room in whichinstrument 150 is positioned. The information projected via projector196 can include the time of day, date, ambient temperature or anyinformation related to an ongoing treatment. For example, FIG. 11 showstreatment data both numerically and graphically. Here, projector 196projects information relating to the current status of a treatment whichis undergoing a second fill that is twenty percent complete. Thisinformation is conveyed both via text and numbers and via a graphic of ahuman body, which is approximately twenty percent colored. Thus apatient lying in bed can quickly glance at, e.g., the ceiling, if thepatient wakes up or looks up from a television to quickly discern whatpoint in the treatment is occurring.

It is contemplated for projector 196 to operate with processing andmemory within instrument 150 to scroll through a series of differentdisplays, for example, displaying time and date at one moment,displaying ambient temperature at another moment, displaying therapyinformation, such as that shown in FIG. 11, at a third moment, andrepeating this cycle, so that the patient can view different datawithout having to physically push a button to change the informationdisplayed. Still further, it is contemplated to provide the patient witha tethered or wireless remote device that allows the patient to scrollthrough or to pick a desired set of information. The information can bedisplayed in a single color, such as red or in multiple colors, such asred, green and blue.

Technology for projector 196 currently exists as described for examplein U.S. Pat. No. 7,252,394, entitled Laser Projection Display AndIllumination Device With MEMS Scanning Mirror For Indoor And OutdoorApplications, assigned on its face to Advanced NuMicro Systems, Inc.(San Jose, Calif.), the entire contents of which are incorporated hereinby reference. In this patent, a projection display system includes alight source emitting a light beam, and a reflecting mirror system forscanning the light beam over an image to illuminate the image. The lightsource can be solid state such as a laser diode operable with a one ormore microelectromechanical systems (“MEMS”) scanning mirrors thatrotate to raster scan the light beam over the image.

Instrument 150 of FIG. 11 further includes wireless capability which cansend and receive information to and from the patient via any suitablewireless communication technology, such as WiFi™, Bluetooth™, Zigbee™ orinfrared technology. System 150 can be outfitted with a wireless headset198 that includes both a speaker for transmitting sound to the patientand a microphone for accepting sound from the patient. Machine 150 inthe illustrated embodiment further includes a groove or channel 202sized and shaped to accept headset 198 when not in use.

Referring now to FIG. 12, instrument 200 illustrates additional featuresconfigured to enhance the usability and effectiveness of the dialysisinstrument and a treatment. Again, various features shown in connectionwith instrument 200 can be combined with various features shown inconnection with instrument 150 of FIG. 11 and vice versa. Instrument 150illustrates certain features configured to aid a blind or visuallyimpaired patient. Instrument 200 of FIG. 12 includes atelecommunications device for the deaf (“TDD”) 210, which is anelectronic device for text communication via a telephone line, used whenone or more of the parties has hearing or speech difficulties. TDD 210is known and is sometimes referred to as a telephone typewriter orteletypewriter (“TTY”), text-phone (common in Europe and the UnitedKingdom) and mini-corn (United Kingdom). TDD 210 includes a phone holder212, which accepts and holds microphone and speaker portions of atelephone. TDD 210 of instrument 200 further includes a fold downkeyboard, which the hearing or speech impaired patient uses to type textinto instrument 200.

Instrument 200 includes processing and memory that convert the text intoa voice output, which is inputted into the microphone of the telephoneinserted into telephone holder 212. Fold down keyboard 214 in oneembodiment exposes a display device 216, which displays text that isconverted from a voice communicating over the telephone through thespeaker of the phone and into a microphone imbedded in one of the phoneholding cavities 212. The processing and memory are further configuredto convert this information to text displayed on secondary displaydevice 216. Secondary display device 216 can be provided in place ofdisplay device 170 or in addition to that display device. TDD 210 can beprovided on any suitable surface of instrument 200.

Instrument 200 further includes a projection device 220, which in theillustrated embodiment is located on a surface onto which a virtualkeyboard 222 is projected. Projection device 220 communicates wirelesslywith instrument 200 in one embodiment. Virtual keyboard 220 asillustrated includes all the letters, numbers and many of the symbolsincluding punctuation, navigational symbols, and other symbols, of astandard keyboard.

One suitable keyboard projector of projector 220 is an I-Tech VKB laserkeyboard manufactured by Hutchison Harbour Ring Limited—HHR, asubsidiary of Hutchison Whampoa Limited (“HWL”). This laser keyboardprojector is about the size of a cellular phone (e.g., 90 mm×34 mm×24mm), which is connected to instrument 200 via a positionable cord 182.Projector 220 in the illustrated embodiment snaps onto a board 224 via asnap holder 226 located on the board. The projection surface does nothave to be board 224 and can for example be any board, tabletop or bookthat is relatively smooth, e.g., does not have projections from thesurface greater than one millimeter. Snap holder 226 however allowsboard 224 to be tilted so that the patient can place board 224 on apillow, which is in turn laid over the patient's stomach when lying inbed. Or, board 224 can be laid in the patient's lap when sitting.

Projector 200 and virtual keyboard 222 enable users to type text intoinstrument 200, e.g., to enter therapy information into the instrumentor to send electronic mail. Projector 200 sends data wirelessly toinstrument 200 in one embodiment, e.g., via WiFi™, Bluetooth or Zigbee™technology. Instrument 200 in turn is configured to be connected to amodem, which allows the instrument to access an internet and to sendelectronic mail.

The above-referenced laser projector uses direction technology based onan optical recognition mechanism, which enables the user to tap on theprojected keys. The projector makes a tapping or clicking noise when avirtual key is touched, providing audible feedback and simulating a realkeyboard. The tapping or clicking noise can be deactivated for bedtimeuse if desired. The laser projector projects a template of the keyboardinterface onto an adjacent interface surface. The template is producedby illuminating a holographic optical element with a red diode laser.The keyboard template serves only as a reference for the user and is notinvolved in the detection process. That is, in a fixed environment, thetemplate could alternatively be printed onto the interface surface orboard.

The projector also projects an infrared plane of light that is generatedjust above, and parallel to, the interface surface. The plane of lightis invisible to the user and hovers a few millimeters above the surface.When the user touches a key position on the interface surface light isreflected from the plane in the vicinity of the key and is directedtowards the sensor module. Reflected light from user interactions withthe interface surface is passed through an infrared filter and imaged onto a complimenatary metal-oxide semiconductor (“CMOS”) image sensor inthe sensor module. Hardware embedded in the sensor chip makes areal-time determination of the location of the reflected light. Thelocation is correlated to a keyboard character or function, which isentered into a memory or buffer of dialysis instrument as data. Theprocessing of projector can track multiple reflection eventssimultaneously and can thus support both multiple keystrokes andoverlapping cursor control inputs.

Symbols selected via virtual keyboard 222 can be displayed for exampleon main display screen 170 or projected on the ceiling, wall, furnitureetc. Also, instrument 200 can be configured to read the typed charactersaloud. The patient can be away from instrument 200 and still inputinformation into the instrument. For example, the patient can be lyingin bed and facing away from the dialysis instrument 200 and still enterinformation into the instrument and have text displayed on theinstrument. The patient can thereby enter information into dialysisinstrument 200 without turning towards the instrument and disruptingcomfortable sleep or relaxing position. In one embodiment, however,dialysis instrument is configured such that the patient has to reviewand confirm all data entered via projector/virtual keyboard, e.g., atdisplay device 170 of instrument 200, before the machine operatesaccording to the data.

It should be understood that various changes and modifications to thepresently preferred embodiments described herein will be apparent tothose skilled in the art. Such changes and modifications can be madewithout departing from the spirit and scope of the present subjectmatter and without diminishing its intended advantages. It is thereforeintended that such changes and modifications be covered by the appendedclaims.

1. A dialysis machine comprising: a dialysate pump; and a graphical userinterface (“GUI”) allowing a patient to program a treatment including atleast one patient fill performed by the dialysate pump, at least onedwell, and at least one patient drain performed by the dialysate pump,the GUI further programmed to provide an alert when it is time to beginthe treatment so as to complete the at least one patient fill, dwell anddrain by a prescribed time.
 2. The dialysis machine of claim 1, thealert a tactile, audio, visual or audio-visual alert.
 3. The dialysismachine of claim 1, wherein a time of the at least one patient fill anda time of the at least one patient drain is preset or calculated basedon dialysate pump rate and fill or drain volume.
 4. The dialysis machineof claim 1, the GUI alert providing for an amount of time to set up thetreatment.
 5. The dialysis machine of claim 1, which includes a remotedevice configured to operate with the GUI, the remote device allowingthe patient to program the treatment remotely.
 6. The dialysis machineof claim 5, wherein the remote device communicates with the GUI viawired or wireless communication.
 7. The dialysis machine of claim 6,wherein the wireless communication uses a wireless communicationtechnology selected from the group consisting of: (a) WiFi; (b)Bluetooth; (c) Zigbee; and (d) infrared.
 8. The dialysis machine ofclaim 1, which includes a remote patient alert device configured tooperate with the GUI to provide a remote alert to the patient when it istime to begin the treatment.
 9. The dialysis machine of claim 8, whereinthe remote alert provided to the patient is set via a wireless datalink.
 10. The dialysis machine of claim 9, wherein the remote alertprovided to the patient is sent to a cellular phone or pager associatedwith the patient.
 11. A dialysis machine comprising: a dialysate pump;and a graphical user interface (“GUI”) allowing a patient to program atreatment including at least one patient fill performed by the dialysatepump, at least one patient dwell, and at least one patient drainperformed by the dialysate pump, the GUI further programmed to adjust atime of the at least one patient dwell automatically so as to be able tocomplete the at least one patient fill, dwell and drain by a prescribedtime.
 12. The dialysis machine of claim 11, wherein a time of the atleast one patient fill and a time of the at least one patient drain ispreset or calculated based on dialysate pump rate and fill or drainvolume.
 13. The dialysis machine of claim 11, which includes a remotedevice configured to operate with the GUI, allowing the patient toprogram the treatment remotely.
 14. The dialysis machine of claim 13,the remote device communicating with the GUI via wired or wirelesscommunication.
 15. The dialysis machine of claim 14, wherein thewireless communication uses wireless communication technology selectedfrom the group consisting of: (a) WiFi; (b) Bluetooth; (c) Zigbee; and(d) infrared.
 16. A dialysis machine comprising: an enclosure; adialysate pump located within the enclosure; a user interface connectedto the enclosure and configured to display a parameter associated withthe dialysate pump; and at least one control feature for controlling thedialysate pump parameter, the control feature selected from the groupconsisting of: (i) a keyboard projected from the enclosure and displayedon a surface separate from the enclosure; (ii) a touch screen withtactile feedback; (iii) a Braille interface; and (iv) atelecommunications device for the deaf (“TDD”) interface.
 17. Thedialysate machine of claim 16, wherein the enclosure includes at leastone feature selected from the group consisting of: (i) a grip for atwist cap; (ii) fingers for a pull cap; (iii) an apparatus configured tobreak a frangible seal; (iv) a drawer for supplies; (v) a clampconfigured to enable a patient to disconnect temporally from themachine; (vi) a night/reading light; and (vii) a utensil holder.
 18. Thedialysis machine of claim 16, wherein the user interface includes atleast one feature selected from the group consisting of: (i) a timer;(ii) an alarm clock; (iii) a music player; (iv) a patient selectablescreen saver; (v) a patient selectable bezel; and (vi) a patientcalendar.
 19. The dialysis machine of claim 16, wherein the projectedkeyboard is provided via a laser, the keyboard operating with aninfrared plane of light that is interrupted to provide at least aportion of the control feature for controlling the dialysate pumpparameter.
 20. The dialysis machine of claim 16, wherein the tactilefeedback touch screen includes one of: (i) tactile bumps molded into anoverlay of the touch screen; (ii) a sheet including tactile bumpslaminated to the touch screen; and (iii) epoxy spots adhered to thetouch screen.
 21. The dialysis machine of claim 16, wherein the Brailleinterface includes characters formed in a touch screen overlay.
 22. Thedialysis machine of claim 16, wherein the TDD includes a telephoneconnection, a keyboard and a video monitor.
 23. The dialysis machine ofclaim 16, which includes a remote device configured to operate with theuser interface, so as to enable a user to navigate to and modify thedisplayed parameter.
 24. The dialysis machine of claim 23, wherein theremote device communicates with the user interface via wired or wirelesscommunication.
 25. The dialysis machine of claim 24, wherein thewireless communication uses wireless communication technology selectedfrom the group consisting of: (a) WiFi; (b) Bluetooth; (c) Zigbee; and(d) infrared.